Health Care Unions Laboring to Unite

Imagine a time when health care unions were endlessly fractured, when labor leaders spent as much time launching public relations attacks and raiding parties against one another as they did trying to organize new workers.

It shouldn’t be too hard to imagine—that was the reality only a year ago.

Today, however, union organizers are banding together under new federations and cooperative anti-raiding agreements. Union leaders say they’ve been forced to grow larger to push their agendas in Washington and to compete with the ever-expanding corporate employers on the other side of the bargaining tables.

Organized labor, in other words, has discovered that its philosophy of workers finding strength in numbers can also apply at the organizational level as well.

Among the developments in the past year, two of health care labor’s most vehement enemies have signed and publicized a peace accord; six state nurse associations have banded together into a new federation; and three more large nurse unions have joined together to form what they’re calling the “super union” of nurses.

In the process, bitter enemies such as the AFL-CIO and the Service Employees International Union have suddenly found themselves with fewer degrees of separation.

“I think the staffing crisis across our industry, which is getting worse and worse because of chronic understaffing … is driving us to link arms with our sister unions,” says Mary Kay Henry, an international executive vice president with the SEIU, which represents more health care workers than any other labor group. “We think that’s necessary now more than ever because of health care reform.”

Experts say developments in Washington have presented many reasons for labor to join forces in support of a single agenda. That includes efforts toward the passage of the Employee Free Choice Act, which would simplify union organizing.

Then there are the pending Senate confirmations of three labor-friendly members of the National Labor Relations Board, and the already seated new secretary of labor, Hilda Solis. Unions are also keenly interested in the passage of health care reform legislation to constrain the insurance costs that have been devouring money that might otherwise have gone toward wage increases.

“They’re putting their differences aside because there’s a bigger prize, and they’re focusing on that,” says James Trivisonno, president of Detroit-based IRI Consultants.

For all the cooperation, though, the unions have not yet been able to leverage their newfound cooperative spirit into the ultimate goal—a larger share of health care workers being organized across the industry. Despite widespread expectations for health care union growth in 2009, workers have remained in a quiet period, with the overall number of union elections actually falling from the year before, according to IRI Consultants’ semiannual report.

In 2008, health care unions held 299 elections, winning 72 percent of them. But in the first half of 2009, only 113 elections were held, with labor winning 73 percent of them, the IRI report says.

Although the number of petitions for elections is on pace to exceed those in 2008, trends indicate that most of these will be withdrawn, dismissed or nullified before elections can take place. In the first half of 2009, 57 percent of election petitions were withdrawn.

Observers say health care union officials prefer to withdraw their petitions prior to elections if it appears they are going to lose a vote, which contributes to their higher-than-average success rate at the ballot box.

Also, IRI authors noted that most of the recent uptick in union petitions is attributable to an anti-SEIU breakaway union, the National Union of Healthcare Workers, which has seen nearly all of its petitions face legal challenges from the SEIU.

And for all the rhetoric about friendship and common goals, there remain several notable splits in the health care labor world that show no signs of repairing. The nurse “super union” actually formed after more than half of the members in one of the three founding organizations left the group in protest of then-ongoing merger talks with the large and ever-growing SEIU.

Standing togetherObservers agree that President Barack Obama, who enjoyed huge union support in 2008, has made clear his desire for unions to set aside their differences and speak with one voice as they press for all the things they want from Washington. Former U.S. Rep. David Bonior, D-Michigan, in April 2009 convened the National Labor Coordinating Committee, in which the AFL-CIO, SEIU and nearly a dozen other labor leaders came together to talk about unification and common strategies.

“We stood together in support of Barack Obama and pro-worker candidates in 2008, and now stand together on the brink of passing both labor law and health care reform,” according to a July 8 statement from Anna Burger, chairwoman of the Change to Win coalition, a group of five unions, including the SEIU, that famously broke away from the AFL-CIO in 2005 in order to start more aggressive unionization drives.

The statement came a week before the joint committee was scheduled to meet with Obama to discuss labor policy issues.

However, it’s not clear that workers will buy into the new unity.

Union leaders say they don’t think their divisive past is a turnoff to new members, but those on the management side say it seems unlikely that workers being courted by organized labor will forget the inter-union bitterness, in which health care unions were raiding one another’s memberships or telling workers that it would be better not to be represented than to join a rival’s organization.

“They’ve spent so much time in the past fighting each other in particular areas, vehemently and with a lot of vitriol … that I think there’s a lot there for these new unions to overcome,” says Dan Rodriguez, vice president of labor relations for the 53-hospital Tenet Healthcare Corp., which has labor agreements with the SEIU and the California Nurses Association/National Nurses Organizing Committee.

The SEIU, by far the largest player in the industry with more than 1 million health care workers, has in particular been dirtied by mudslinging in its public battles with the California Nurses Association/National Nurses Organizing Committee, and with the National Union of Healthcare Workers. The SEIU has called a truce with the former and waged a public relations counterassault against the latter.

Nationally, union membership suffered while the unions stepped up their infighting.

Among all industries, union representation reached an all-time low in 2006, with just 12 percent of the workforce belonging to a union. In 2007, the union membership rate showed its first positive growth in more than two decades, rising slightly to 12.1 percent, according to the U.S. Bureau of Labor Statistics.

The Union Membership and Coverage Database, maintained by researchers Barry Hirsch and David Macpherson using BLS data, says 17 percent of hospitals’ 6.2 million workers were unionized in 2008, the most recent data available. Among nurses, nearly 20 percent of the 2.7 million registered nurses in the nation were unionized.

Although experts predict a much higher number of unionization petitions to be filed in 2009 compared with last year, it’s difficult to speculate how many would result in elections, let alone union victories.

As organized labor membership figures dwindled in part through the use of aggressive anti-union consulting by employers, unions have experienced a corresponding uptick in the aggressiveness of their own tactics, according to Rose Ann DeMoro, executive director of California Nurses Association/National Nurses Organizing Committee, which is regarded by management labor attorneys as one of the most aggressive unions to contend with.

“Union-busters end up feeding off the health care industry,” DeMoro says. “Weaker unions fall to the wayside in trying to confront that. … The more formidable organizations are the ones that have survived these times.”

Breaking awayOne major outlier to the consolidation trend is California’s National Union of Healthcare Workers. The union is an Oakland-based breakaway organization led by former SEIU officials who were ousted by the international union over alleged financial irregularities after months of infighting.

The union’s officials want workers at California hospitals to decertify their SEIU units and join their new group. In the first six months of 2009, the union filed at least 82 petitions to form or decertify bargaining units, which was a major reason why California accounted for nearly half of all the petitions for union activity in the country in the first half of 2009.

Last week, the National Union of Healthcare Workers scored a success: Several thousand hospital and clinic workers employed by Kaiser Permanente voted to leave SEIU and join the upstart union.

In the closely watched election, the much smaller union overwhelmingly won three simultaneous disaffiliation votes, representing about 2,300 workers at Kaiser's 412-bed Los Angeles Medical Center and more than 90 affiliated clinics in Southern California.

Although the changes causing the newfound optimism in the health care labor movement affect all kinds of bargaining units, the forces converging to organize nurses constitute a distinct movement within the industry.

In April, the nursing associations of six states—Montana, New Jersey, New York, Ohio, Oregon and Washington—banded together to form the National Federation of Nurses. All had formerly been affiliated with United American Nurses, a nurses-only union that began as an offshoot of the American Nurses Association.

On April 30, 2009, United American Nurses entered into a provisional affiliation agreement with the California Nurses Association/National Nurses Organizing Committee and the Massachusetts Nurses Association to establish an interim governing structure for a new “super union” called National Nurses United. United American Nurses officials said they had been meeting with the two groups since January 2009 to work out details for how to merge.

And on December 7, the new national union, comprising as many as 154,000 registered nurses, was formally created at a meeting in Phoenix. It selected Rose Ann DeMoro as its executive director

“I think the debate over health care [reform] probably finally pushed us to get here, but it’s something that we should have done a long time ago and it’s thrilling that we’re finally doing it,” said Karen Higgins, a staff nurse at Boston Medical Center and co-president of National Nurses United.

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